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51.
New York City experienced the first and largest HIV epidemic among injecting drug users (IDUs). Using data collected from IDUs entering the Beth Israel drug detoxification program, we trace the history of this epidemic from the mid-1970s through the early 2000s. The epidemic can best be described in terms of successive stages: (1) introduction and rapid transmission of HIV in the IDU population; (2) stabilization of HIV prevalence at a high level (over 50%); (3) a decline in incidence and prevalence, following large-scale implementation of syringe exchange programs; and (4) a sexual transmission phase, in which HIV prevalence is approximately equal among injecting and noninjecting heroin and cocaine users, and sexual transmission is more important than injecting-related transmission among IDUs. Given the current spread of HIV among IDUs in many places in the world, New York City provides a very strong example for implementation of large-scale comprehensive syringe exchange programs as early as possible in HIV epidemics among IDUs. 相似文献
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Alison L Steiber Kamyar Kalantar-Zadeh Donna Secker Maureen McCarthy Ashwini Sehgal Linda McCann 《Journal of renal nutrition》2004,14(4):191-200
Nutritional assessment of patients with chronic kidney disease is a vital function of health care providers. Subjective Global Assessment (SGA) is a tool that uses 5 components of a medical history (weight change, dietary intake, gastrointestinal symptoms, functional capacity, disease and its relation to nutritional requirements) and 3 components of a brief physical examination (signs of fat and muscle wasting, nutrition-associated alternations in fluid balance) to assess nutritional status. SGA was originally used to predict outcomes in surgical patients; however, its use has gone beyond this function and population. In chronic kidney disease patients, SGA is incorporated into the complete nutritional assessment. Validation of SGA as a screening tool for surgical patients was done by Detsky et al in 1984. Since that time, SGA has been altered by different researchers and clinicians to better meet the needs of the patients they served. Validation of the altered SGA formats has not been thoroughly done. Further work in establishing validity and reliability of each version of SGA in different patient populations should be done to enable clinicians and researchers to properly use this nutritional assessment tool. 相似文献
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Rajnish Mehrotra Vanessa Ravel Elani Streja Sooraj Kuttykrishnan Scott V. Adams Ronit Katz Miklos Z. Molnar Kamyar Kalantar-Zadeh 《Clinical journal of the American Society of Nephrology》2015,10(11):1990-2001
Background and objectives
Although a peritoneal equilibration test yields data on three parameters (4-hour dialysate/plasma creatinine, 4- to 0-hour dialysate glucose, and 4-hour ultrafiltration volume), all studies have focused on the prognostic value of dialysate/plasma creatinine for patients undergoing peritoneal dialysis. Because dialysate 4- to 0-hour glucose and ultrafiltration volume may be superior in predicting daily ultrafiltration, the likely mechanism for the association of peritoneal equilibration test results with outcomes, we hypothesized that they are superior to dialysate/plasma creatinine for risk prediction.Design, setting, participants, & measurements
We examined unadjusted and adjusted associations of three peritoneal equilibration test parameters with all-cause mortality, technique failure, and hospitalization rate in 10,142 patients on peritoneal dialysis treated between January 1, 2007 and December 31, 2011 in 764 dialysis facilities operated by a single large dialysis organization in the United States, with a median follow–up period of 15.8 months; 87% were treated with automated peritoneal dialysis.Results
Demographic and clinical parameters explained only 8% of the variability in dialysate/plasma creatinine. There was a linear association between dialysate/plasma creatinine and mortality (adjusted hazards ratio per 0.1 unit higher, 1.07; 95% confidence interval, 1.02 to 1.13) and hospitalization rate (adjusted incidence rate ratio per 0.1 unit higher, 1.05; 95% confidence interval, 1.03 to 1.06). Dialysate/plasma creatinine and dialysate glucose were highly correlated (r=−0.84) and yielded similar risk prediction. Ultrafiltration volume was inversely related with hospitalization rate but not with all-cause mortality. None of the parameters were associated with technique failure. Adding 4- to 0-hour dialysate glucose, ultrafiltration volume, or both did not result in any improvement in risk prediction with dialysate/plasma creatinine alone.Conclusions
This analysis from a large contemporary cohort treated primarily with automated peritoneal dialysis validates dialysate/plasma creatinine as a robust predictor of outcomes in patients treated with peritoneal dialysis. 相似文献58.
Angelo Karaboyas Jarcy Zee Hal Morgenstern Jacqueline G. Nolen Raymond Hakim Kamyar Kalantar-Zadeh Philip Zager Ronald L. Pisoni Friedrich K. Port Bruce M. Robinson 《Clinical journal of the American Society of Nephrology》2015,10(10):1814-1821
Background and objectives
Anemia management changed substantially among dialysis patients in the United States around the time of implementation of the new Centers for Medicare & Medicaid Services bundled payment system and erythropoiesis-stimulating agent (ESA) label change in 2011. Among these, average ferritin levels increased dramatically and have remained high since; this study sought to gain understanding of this sustained rise in ferritin levels.Design, setting, participants, & measurements
Trends in mean ferritin, hemoglobin, IV iron dose, and ESA dose from 2009 to 2013 were examined in 9735 patients from 91 United States Dialysis Outcomes and Practice Patterns Study facilities. Linear mixed models were used to assess the extent to which intravenous (IV) iron and ESA dose accounted for patients’ changes in ferritin over time.Results
Mean ESA dose and hemoglobin levels declined throughout the study. Mean IV iron dose increased from 210 mg/mo in 2009–2010 to a peak of 280 mg/mo in 2011, then declined back to 200 mg/mo and remained stable from 2012 to 2013. Mean ferritin increased from 601 ng/ml in the third quarter of 2009 to 887 ng/ml in the first quarter of 2012; models suggest that higher IV iron dosing was a primary determinant during 2011, but lower ESA doses contributed to the sustained high ferritin levels thereafter. In a subset of 17 facilities that decreased IV iron dose in 2011, mean ferritin rose by 120 ng/ml to 764 ng/ml, which appeared to be primarily due to ESA reduction. Together, changes in IV iron and ESA doses accounted for 46% of the increase in ferritin over the study period.Conclusions
In contrast to expectations, the rise in average IV iron dose did not persist beyond 2011. The sustained rise in ferritin levels in United States dialysis patients after policy changes in 2011, to average levels well in excess of 800 ng/ml, appeared to be partly due to reductions in ESA dosing and not solely IV iron dosing practices. The effect of these changes in ferritin on health outcomes requires further investigation. 相似文献59.
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Gangadarshni Chandramohan Kamyar Kalantar-Zadeh Dulcie Kermah Sheena Cecille Marie Go Nosratola D. Vaziri Keith C. Norris 《Journal of the American Society of Hypertension》2012,6(4):277-283
BackgroundObesity is a known cardiometabolic risk factor in children. In adults, pulse pressure (PP) is a known predictor and a risk factor of cardiovascular (CV) diseases. In this study, we examined the association between measures of obesity and PP in children.MethodsA retrospective analysis of 4667 children ages 6–17 years from the National Health and Nutrition Survey (1988–1994) was performed. We defined wide PP as 4th quartile PP and high waist circumference (WC) as >75th percentile based on age and gender.ResultsThere were 51% boys, 74% whites, 16% blacks, 10% Hispanics, 12% obese, 26% with high WC, 26% with wide PP, and 9% with high blood pressure (BP). Prevalence of wide PP was high among obese children. A significantly higher mean PP was observed in boys, Blacks, obese, those with high WC and high BP. The adjusted odds ratio (OR) for wide PP was higher in boys, Blacks, and those with high WC.ConclusionThere was a statistically significant independent association observed between wide PP and high WC, but not with obesity based on BMI. Further exploration of wide PP as a CV risk factor in childhood and its relationship to CV outcomes appears warranted. 相似文献